Ear pain - Otalgia

Definition of otalgia

The term "otalgia" is used in the medical field to indicate a generic pain in the ears. The severity of the disorder and the intensity of the pain clearly depend on the cause that triggered the otalgia.

Ear pain can be perceived as continuous, intermittent, pulsating, rhythmic, dull or unbearable. Contrary to what can be assumed, otalgia does not depend only on ear diseases: often, in fact, earache is a secondary consequence of other conditions, such as sinusitis, tonsillitis, colds, flu, toothache, migraine and throat cancer. More often, moreover, the otalgia does not remain circumscribed to the ears: more often the pain radiates also to the nape and the neck, constituting a real and true discomfort.

In general, two forms of ear pain can be distinguished:

1. Primary otalgia: ear pain originates within the organ
2. Secondary otalgia (also called "reported" otalgia): earache originates "outside" and does not depend on a pathology of the ears

Primary otalgia

In the primary form of otalgia, the perceived pain depends on pathologies affecting the external ear, medium or internal.

CAUSES OF PRIMARY OTALGIA
	Bad to the outer ear	Hurt in the middle ear
Mechanical causes	Furunculus in the auricle Insertion of foreign bodies in the ear (eg marbles, games, insects, etc.) Plug of earwax Ear trauma	Barotrauma (damage caused by the lack of balance between air pressure in the ear and environmental pressure) Obstruction of the Eustachian tube Shampoo or soap residue in the ear
Infectious-inflammatory causes	Candidiasis and otomycosis Staphylococcus infection Pseudomonas infection Herpes zoster infection Viral or bullous myringitis Sjögren syndrome	Acute otitis media Purulent otitis media Acute mastoiditis

Secondary otalgia

The secondary form of otalgia is also called "referred" to highlight that pain is also perceived at the ear level, despite the fact that it actually originates in other locations.

The region of the ear is innervated by four cranial nerves and two spinal innervations, consequently a lesion or a pathology affecting these communication pathways can give rise to otalgia.

In this sense, the causes triggering secondary otalgia are :

• Toothache and tooth abscesses (cause of extremely common earache), bruxism, swollen parotid: caused by lesions on the facial nerve
• Pharyngitis, tonsillitis, nasopharyngitis, oropharynx carcinoma: caused by lesions of the glossopharyngeal nerve
• Oral cavity cancer, trigeminal neuralgia, sinusitis, nasal obstruction: caused by lesions of the trigeminal nerve
• Laryngopharyngitis, laryngeal carcinoma, bronchitis, esophagitis: caused by damage to the vagus nerve

Cervical osteoarthritis, cervical pain and cervical lesions can also cause ear pain.

When it is not possible to trace a precise cause, one speaks of idiopathic otalgia.

Diagnosis

The investigative investigation for ear pain begins with the anamnesis, that is, with the collection of information directly from the patient. The doctor will analyze the intensity of the pain, the duration, the possible difficulty in swallowing, the toothache, the basal temperature and the past history of the patient (in terms of previous illnesses).

The otoscopic examination is useful for identifying the possible causes triggering pain in the ears (eg otitis media, earwax cap, etc.). If the aforementioned diagnostic investigation does not report any satisfactory results, we proceed with the analysis and evaluation of the integrity of the cranial nerves.

For a correct diagnostic investigation, it is advisable to also examine the nose, paranasal sinuses, oropharynx, nasopharynx, parotids, larynx and trachea, to assess their state of health.

Also the audiography and chest X-ray may sometimes be performed for further investigation.

In the event of dysphagia, intermittent fever, lymphadenopathy, altered tone of voice and sudden weight loss, it is essential to consider the possibility of a neoplastic disease in progress.

Remedies and therapies

Given that earache is a common symptom of many diseases, it is essential to identify the trigger before proceeding with any drug. Only then can specific therapy be followed.

Earache dependent on bacterial infections should be treated with specific antibiotic therapy; the use of antiviral or antifungal drugs is recommended instead for infections sustained respectively by viruses (eg. Herpes) or mycetes (eg Candida, Aspergillus).

Oncology-based otalgia should be treated with specific chemotherapy drugs: consult a doctor.

Extremely recurrent is the otalgia dependent on flu diseases (colds, sinusitis, flu etc.): in this case, the disorder must be treated with generic therapeutic aids, such as paracetamol (to lower fever), ibuprofen and aspirin (to reduce pain : do not give acetylsalicylic acid to children under the age of 12).

Another effective remedy to reduce otalgia is the application of hot compresses directly on the ear: heat, in fact, reduces and relieves - albeit temporarily - ear pain.